Lung Ultrasound Is Often, but Not Always, Normal in Healthy Subjects: Considerations for COVID-19 Pandemic

Background: Lung ultrasound (LU) is becoming an increasingly important diagnostic tool in detecting lung involvement in Corona Virus Disease 2019 (COVID-19). The aim of this study was to ascertain the likelihood of finding LU abnormalities; mimicking lung involvement; in COVID-19 negative healthy individuals. Methods: We performed LU on 265 healthcare workers; not presenting COVID-19 major symptoms and in good health; during the course of a serological screening program for COVID-19 in our General Hospital. LU results were reported as total Lung Ultrasound Score (LUS) using a 12-zone method of reporting. Results: 250/265 subjects were included in the COVID-19 negative group. LU was not completely normal (LUS not equal 0) in 65/250 COVID-19 negative subjects (26%) and in 12/15 (80%) poorly symptomatic COVID-19 positive subjects; with a multifocal pattern in 12.7% vs. 66.7% of cases respectively. Age and COVID-19 positivity were independent predictors of total LUS. A total LUS >= 2 had a sensitivity of 66.67% and a specificity of 85.60% in detecting COVID-19 positivity. Conclusions: A slightly altered LU can be quite frequent in healthy COVID-19 negative subjects. LU can have a role in confirming but not screening COVID-19 poorly symptomatic cases.

Automated summary

This study aimed to determine the likelihood of finding LU abnormalities in COVID-19 negative healthy individuals, and found that a slightly altered LU can be quite frequent in healthy COVID-19 negative subjects. Age and COVID-19 positivity are independent predictors of total LUS, and a total LUS ≥ 2 has reasonable sensitivity and specificity in detecting COVID-19 positivity, but LU may not be effective in screening poorly symptomatic cases.